{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T19:05:54Z","timestamp":1772132754519,"version":"3.50.1"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,8,30]],"date-time":"2019-08-30T00:00:00Z","timestamp":1567123200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003958","name":"Stichting voor de Technische Wetenschappen","doi-asserted-by":"publisher","award":["10903"],"award-info":[{"award-number":["10903"]}],"id":[{"id":"10.13039\/501100003958","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011703","name":"Yorkshire Cancer Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011703","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000691","name":"Academy of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:p>Intersphincteric resection (ISR) enables radical sphincter\u2010preserving surgery in a subset of low rectal tumors impinging on the anal sphincter complex (ASC). Excellent anatomical knowledge is essential for optimal ISR. This study describes the role of the longitudinal muscle (LM) in the ASC and implications for ISR and other low rectal and anal pathologies. Six human adult en bloc cadaveric specimens (three males, three females) were obtained from the University of Leeds GIFT Research Tissue Programme. Paraffin\u2010embedded mega blocks containing the ASC were produced and serially sectioned at 250\u2009\u03bcm intervals. Whole mount microscopic sections were histologically stained and digitally scanned. The intersphincteric plane was shown to be potentially very variable. In some places adipose tissue is located between the external anal sphincter (EAS) and internal anal sphincter (IAS), whereas in others the LM interdigitates to obliterate the plane. Elsewhere the LM is (partly) absent with the intersphincteric plane lying on the IAS. The LM gave rise to the formation of the submucosae and corrugator ani muscles by penetrating the IAS and EAS. In four of six specimens, striated muscle fibers from the EAS curled around the distal IAS reaching the anal submucosa. The ASC formed a complex structure, varying between individuals with an inconstant LM affecting the potential location of the intersphincteric plane as well as a high degree of intermingling striated and smooth muscle fibers potentially further disrupting the plane. The complexity of identifying the correct pathological staging of low rectal cancer is also demonstrated. Clin. Anat. 33:567\u2013577, 2020. \u00a9 2019 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ca.23444","type":"journal-article","created":{"date-parts":[[2019,8,6]],"date-time":"2019-08-06T06:59:06Z","timestamp":1565074746000},"page":"567-577","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The role of the longitudinal muscle in the anal sphincter complex"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2990-3073","authenticated-orcid":false,"given":"Anne C.","family":"Kraima","sequence":"first","affiliation":[{"name":"Department of Anatomy &amp; Embryology Leiden University Medical Center  Leiden The Netherlands"},{"name":"Department of Informatics University of Bergen  Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas P.","family":"West","sequence":"additional","affiliation":[{"name":"Department of Informatics University of Bergen  Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Informatics University of Bergen  Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek R.","family":"Magee","sequence":"additional","affiliation":[{"name":"Mohn Medical Imaging and Visualization Centre Department of Radiology, Haukeland University Hospital, Bergen  Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noeska N.","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Informatics University of Bergen  Norway"},{"name":"Mohn Medical Imaging and Visualization Centre Department of Radiology, Haukeland University Hospital, Bergen  Norway"},{"name":"Computer Graphics and Visualization, Department of Intelligent Systems Delft University of Technology  Delft The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelis J. H.","family":"van de Velde","sequence":"additional","affiliation":[{"name":"Department of Surgery Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco C.","family":"DeRuiter","sequence":"additional","affiliation":[{"name":"Department of Anatomy &amp; Embryology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harm J.","family":"Rutten","sequence":"additional","affiliation":[{"name":"Department of Surgery Catharina Hospital Eindhoven  Eindhoven The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Quirke","sequence":"additional","affiliation":[{"name":"Department of Informatics University of Bergen  Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-013-0774-3"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7580.2009.01091.x"},{"key":"e_1_2_7_4_1","first-page":"309","volume-title":"Proceedings of Simulation and Visualization","author":"Botha CP","year":"2008"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12573"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2008.11.039"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01011535"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000865"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-6144-x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02050295"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02586429"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5489"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-014-2038-0"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181fc9378"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3573-1"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800790908"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.20633"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.8677"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.12.130.287"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(50)90207-8"},{"key":"e_1_2_7_21_1","first-page":"88","article-title":"Surgical anatomy of the anal canal with special reference to the surgical importance of the internal sphincter and conjoint longitudinal muscle","volume":"19","author":"Morgan CN","year":"1956","journal-title":"Ann R Coll Surg Engl"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800590909"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)92612-7"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpath.2012.01.033"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.217.2.r00nv13395"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000154551.06768.e1"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800810944"},{"key":"e_1_2_7_28_1","first-page":"271","article-title":"A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. III. The longitudinal anal muscle: Anatomy and role in anal sphincter mechanism","volume":"13","author":"Shafik A","year":"1976","journal-title":"Invest Urol"},{"key":"e_1_2_7_29_1","first-page":"412","article-title":"A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. The external anal sphincter: A triple\u2010loop system","volume":"12","author":"Shafik A","year":"1975","journal-title":"Invest Urol"},{"key":"e_1_2_7_30_1","first-page":"241512","article-title":"Intersphincteric resection for low rectal cancer: An overview","volume":"2012","author":"Spanos CP","year":"2012","journal-title":"Int J Surg Oncol"},{"key":"e_1_2_7_31_1","first-page":"4","volume-title":"The ASCRS Textbook of Colon and Rectal Surgery","author":"Steele SR","year":"2011"},{"key":"e_1_2_7_32_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/978-3-642-18977-7","volume-title":"Anorectal and Colon Diseases: Textbook and Color Atlas of Proctology","author":"Stein E","year":"2003"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000103070.13030.eb"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12253-014-9863-x"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5534"}],"container-title":["Clinical Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fca.23444","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ca.23444","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ca.23444","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ca.23444","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T03:43:50Z","timestamp":1694058230000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ca.23444"}},"subtitle":["Implications for the Intersphincteric Plane in Low Rectal Cancer Surgery?"],"short-title":[],"issued":{"date-parts":[[2019,8,30]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1002\/ca.23444"],"URL":"https:\/\/doi.org\/10.1002\/ca.23444","archive":["Portico"],"relation":{},"ISSN":["0897-3806","1098-2353"],"issn-type":[{"value":"0897-3806","type":"print"},{"value":"1098-2353","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,30]]},"assertion":[{"value":"2018-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}